Prevention of ventilator‑associated pneumonia by noble metal coating of endotracheal tubes: a multi‑center, randomized, double‑blind study

BACKGROUND: Ventilator-associated pneumonia (VAP) causes increased mortality, prolonged hospital stay and increased healthcare costs. Prevention of VAP in intensive care units (ICUs) is currently based on several measures, and application of noble metal coating on medical devices has been shown to inhibit the bacterial adherence of microorganisms to the surface. The objective of this study was to evaluate the potential benefit of noble metal coating of endotracheal tubes for the prevention of VAP. METHODS: This was a multi-center, randomized, controlled, double-blind, prospective study including ventilated patients from nine ICUs from four hospital sites in Belgium. Patients were randomly intubated with identical appearing noble metal alloy (NMA) coated (NMA-coated group) or non-coated (control group) endotracheal tubes (ETT). Primary endpoint was the incidence of VAP. Secondary endpoints were the proportion of antibiotic days during ICU stay and tracheal colonization by pathogenic bacteria. RESULTS: In total, 323 patients were enrolled, 168 in the NMA-coated group and 155 in the control group. During ventilation, VAP occurred in 11 patients (6.5%) in the NMA-coated group and in 18 patients (11.6%) in the control group (p  = 0.11). A higher delay in VAP occurrence was observed in the NMA-coated group compared with the control group by Cox proportional hazards regression analysis (HR 0.41, 95% CI 0.19–0.88, p  = 0.02). The number of antibiotic days was 58.8% of the 1,928 ICU days in the NMA-coated group and 65.4% of the 1774 ICU days in the control group (p  = 0.06). Regarding tracheal colonization, bacteria occurred in 38 of 126 patients in the NMA-coated group (30.2%) and in 37 of 109 patients in the control group (33.9%) (p  = 0.57). CONCLUSIONS: This study provides preliminary evidence to support the benefit of noble metal coating in the prevention of VAP. A confirmatory study in a larger population would be valuable. Trial registration: Clinical trial number: NCT04242706 (http://www.clinicaltrials.gov

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Diel activity of Sarpa salpa (Sparidae) by ultrasonic telemetry in a Posidonia oceanica meadow of Corsica (Mediterranean Sea)

In the Mediterranean Sea, the fish Sarpa salpa (Sparidae) is the only vertebrate grazer of Posidonia oceanica meadows. In order to gain knowledge about the behaviour of S. salpa and a better understanding of the meadow's primary production recycling, an original study was designed using ultrasonic telemetry to investigate activity patterns and space utilisation in the field. During June-September 2000, we compared diel movements of, six adult S. salpa (249-317 nim FL and 313-633 g) in the Bay of Calvi. These fish were tagged by intraperitoneal insertion of ultrasonic transmitters. Their positions were recorded with a directional hydrophone from a small boat with an accuracy between 10 and 50 m, depending on the local environment. The tracking duration ranged from 3 to 22 days (average 11.8 +/- 7.3). Locations were performed from at least dawn to dusk or early night, and one fish was tracked during the entire 24-h cycle. Fish were more mobile during the twilight periods, but statistical analysis indicated individual differences for the precise period of mobility. Two major behavioural patterns were observed: first, the fish remained in close vicinity of the harbour during the day and moved away to the north or the south at dusk to access nocturnal sites, occupying a home range of about 4.3 ha. The second behavioural pattern involved persistent occupation of the same sites during day and night within a relatively restricted home range (about 0.8 ha). Great variation in mobility was found and the same individual fish could show both kinds of behaviour. (C) 2002 Ifremer/CNRS/Inra/IRD/Cemagref/Editions scientifiques et medicales Elsevier SAS. All rights reserved

Managing Coral Reef Fish Community Biomass is a Priority for Biodiversity Conservation in Madagascar

Elucidating factors that influence natural resources and diversity can assist managing species and their ecological functions. Key management options include protecting unique locations or implementing restrictions that more broadly protect ecological attributes and their services. To evaluate these 2 options, we examined 23 fish families in 152 unique sites in the Western and Northern Madagascar Ecoregion to test for spatial aggregation, environmental, habitat, and human influences on the fish communities. We found that there were 10 distinct communities of fish and that they were widely distributed in the region. Biomass and diversity were closely associated with the community types and showed weak spatial aggregation and environmental and market influences

Impact implantation of a transmitter on Sarpa salpa behaviour: study with a computerized video tracking system

peer reviewedTwo transmitter masses (2 and 6% of the fish's mass) were selected to examine the interference of tags with the behaviour of Sarpa salpa using a computerized video tracking system based on digital imaging techniques. The study demonstrated that light transmitters had no effect on the behavioural variables studied, and a substantial bias in behaviour is introduced if heavier (6%) tags are used. (c) 2005 The Fisheries Society of the British Isles